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HumanaChoice H5216-464 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-464 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-464 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-464 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2026 to people living in Honolulu, Kauai, Maui. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-464 (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HumanaChoice H5216-464 (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For HumanaChoice H5216-464 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $39.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10100.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The HumanaChoice H5216-464 (PPO) Medicare plan features an annual drug deductible of $615 and offers affordable options for generic medications. You will pay no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through preferred mail order. For Tier 2 generic drugs, copays are as low as $5 for a one-month supply, with no copay required for a three-month supply ordered through preferred mail delivery. Tier 3 preferred brand drugs carry a $47 copay for a one-month supply, which can be optimized to a $94 copay for a three-month supply using preferred mail order. Higher-tier medications require coinsurance, including a 28% coinsurance for Tier 4 non-preferred drugs and a 25% coinsurance for Tier 5 specialty drugs. These cost-sharing tiers help you understand your out-of-pocket prescription expenses under this HumanaChoice PPO plan.
Additional Benefits
The HumanaChoice H5216-464 (PPO) plan offers comprehensive medical coverage with no copay for primary care physician visits, while specialist visits and therapies require a $40 copay. Inpatient hospital stays feature a $350 daily copay for the first five days and no copay thereafter, while emergency care carries a $130 copay. Additionally, most outpatient services and diagnostic lab tests are covered with no coinsurance and low-to-no copays. Routine dental, vision, and hearing services are covered with no copays for annual exams, though specific caps and copays apply for restorative care, eyewear, and hearing aids. While home health services feature no copay or coinsurance, durable medical equipment and dialysis services require a 20% coinsurance. It is important to note that this plan does not cover transportation, over-the-counter items, or cardiac rehabilitation services.
Inpatient Hospital See details
HumanaChoice H5216-464 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $350 daily copay for days 1 through 5 and no copay for days 6 and beyond. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5216-464 (PPO) covers outpatient services with no coinsurance, featuring a copay of $0 to $350 for outpatient hospital services and $350 per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay or coinsurance, while outpatient substance abuse sessions require a $25 to $35 copay and no coinsurance.
Partial Hospitalization See details
HumanaChoice H5216-464 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
HumanaChoice H5216-464 (PPO) covers ground ambulance services with a $155.00 copay and air ambulance services with a $1,250.00 copay, both featuring no coinsurance and requiring prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice H5216-464 (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance, with none of these costs counting toward a deductible.
Primary Care See details
HumanaChoice H5216-464 (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits and physical, occupational, and speech therapies require a $40 copay and no coinsurance. Mental health, psychiatric, and podiatry services feature copays ranging from $25 to $40 with no coinsurance, though chiropractic services are not covered.
Preventive Services See details
HumanaChoice H5216-464 (PPO) features partially covered preventive services with no copay and no coinsurance for covered options like annual physical exams, kidney disease education, and memory fitness benefits. However, many supplemental services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
HumanaChoice H5216-464 (PPO) hearing services are covered with no deductible, featuring a $40 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance for up to two aids yearly, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services under HumanaChoice H5216-464 (PPO) are partially covered, featuring no coinsurance and no copay for one annual routine eye exam and one pair of eyeglasses or contact lenses. There is a $75 annual limit for eye exams (which have a $0 to $40 copay depending on the exam) and a $100 annual eyewear limit, while separate eyeglass lenses, frames, upgrades, and other eye exam services are not covered.
Dental Services See details
HumanaChoice H5216-464 (PPO) offers partially covered dental services with a $1,500 annual maximum benefit, featuring no copay and no coinsurance for most preventive care, a $40 copay and no coinsurance for Medicare-covered dental, and a $25 copay and no coinsurance for restorative services. Fluoride treatments, maxillofacial prosthetics, implants, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
HumanaChoice H5216-464 (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, carry a coinsurance of 0% to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered by HumanaChoice H5216-464 (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HumanaChoice H5216-464 (PPO) covers medical equipment, including durable medical equipment and prosthetic devices with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay and coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under HumanaChoice H5216-464 (PPO), with lab services featuring no copay and no coinsurance, and diagnostic procedures carrying a $0 to $150 copay with no coinsurance. Diagnostic radiological services have a minimum $0 copay, outpatient X-rays have no copay but require coinsurance, and therapeutic radiological services require a copay and at least 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the HumanaChoice H5216-464 (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HumanaChoice H5216-464 (PPO) plan, as standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice H5216-464 (PPO) with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required and a prior three-day hospital stay is not needed, but additional days beyond the standard 100 days are not covered.
Other Services See details
HumanaChoice H5216-464 (PPO) partially covers other services, including acupuncture with a $40 copay and no coinsurance for up to 20 treatments annually, and a chronic illness meal benefit with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this plan.
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